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DOI: 10.1590/1413-81232021262.41072020 465
Transition to fatherhood in the prenatal period: a qualitative
article
study
Catarina Silva (https://orcid.org/0000-0002-7597-9343) 1
Cândida Pinto (https://orcid.org/0000-0003-4874-6728) 2
Cristina Martins (https://orcid.org/0000-0003-2047-6607) 3
Abstract Becoming a father requires a process of
personal development, inner reorientation, and
adaptation to a new role. The literature on this
process has been sparse, devaluing how challen-
ging and problematic the transition to becoming
a father can be. This qualitative, exploratory, des-
criptive, cross-sectional and retrospective study
sought to understand the experiences of men in
the transition to fatherhood during the prenatal
period. It included a sample of 10 men experien-
cing, for the first time, a partner’s pregnancy. The
data collection technique used was semi-struc-
tured interviews. The content analysis technique
with semantic categorization and an inductive
approach was used to analyze the data. As a re-
sult, 3 topics emerged: “experiencing the transi-
tion,” “development of the father identity” and
“(de)constructing bridges for the transition”. This
study deepens the understanding of this develo-
pmental transition and challenges the restructu-
ring of prenatal care towards the inclusion of the
father figure.
Key words Men, Fathers, Pregnancy, Nursing
1
ACES Alto Ave. Portugal.
R. Francisco Fernandes
Guimarães, Urgezes. 4810-
503 Guimarães Portugal.
catsilva@gmail.com
2
Escola Superior de
Enfermagem do Porto.
Porto Portugal.
3
Escola Superior de
Enfermagem, Universidade
do Minho. Minho Portugal.466
Silva C et al.
Introduction tal transition experienced by men during the pre-
natal period?. We aim to understand the experi-
Historically, men have been considered as sec- ences of the transition to fatherhood, during the
ondary, and sometimes unnecessary, in the tran- prenatal period, of first-time fathers.
sition process to fatherhood, and media represen-
tations disseminate and reinforce these cultural
messages1. Nevertheless, the literature shows that Methods
men provide unique contributions in this tran-
sition2 and influence the growth / development This is an exploratory, descriptive, cross-section-
and well-being of children3. Currently, we see al and retrospective study, included in a qualita-
fatherhood characterized by a more affectionate tive research paradigm. The qualitative research
masculinity, and fathers more involved in preg- allows the understanding of behaviors from the
nancy and birth, and in the care and education of perspective of the people being assessed and col-
their children4. Such differences highlight a sce- lection of data that is rich in descriptive details
nario of instability in the presence of fatherhood in relation to people, places and conversations,
and the complexities of family life and require a allowing the acceptance of the wealth of human
broad reflection on what it means to be a father experience15, assuming here a structuring func-
and mother in the 21st century5. tion16.
Becoming a father is a challenging journey for The study was developed with fathers who
men, a transformative process of metamorphosis were taking the Childbirth Preparation Course
that starts during pregnancy6. Pregnancy is a de- at a care unit in the northern region of Portu-
manding period in terms of psychological reor- gal. The choice of this health unit was based on
ganization of the self7 and it is during this period a convenience criterion, due to the geographical
that the desire to be a good father begins8. The proximity to the place where we develop our dai-
enthusiasm and joy experienced by the future ly professional practice.
birth of a child is commonly penetrated by the The participants met the following inclusion
fear of becoming a father, by feeling unprepared criteria: men experiencing their partner’s preg-
and insecure when confronted with one’s part- nancy for the first time, in the last trimester of
ner’s expectations about their role as a father9. pregnancy, who lived with their partners and
Not being prepared for this transition can gestation without maternal-fetal pathology, and
have important implications for the relationship who agreed to participate in the study.
between the couple and the parent/child dyad, Ten men participated in the study, aged be-
the baby’s development10 and the entire family11. tween 27 and 40 years old, of which 8 were mar-
The literature highlights that men’s involvement ried and 2 had a common-law marriage, with
since the early stages of pregnancy, in addition to different professions (2 businessmen, 1 physical
promoting their own psychological well-being12, education teacher, 1 nurse, 1 physician, 1 electri-
extends to the entire family unit11. cian, 2 real estate agents, 1 salesman and 1 factory
Nursing has contributed to the understanding worker) and level of schooling ranging between
of the transition concept from the perspective of the second year of high school and a university
people’s life and health, defining it as “a passage degree. The pregnant partners had gestational
or movement from one state, condition or place ages ranging between 33 and 38 weeks at the time
into another”13, implying that people will reach a of data collection. The sample representativeness
period of greater stability14. The study of transi- was determined by data saturation17.
tions is particularly relevant, because the vulner- Data collection was carried out using the
ability of people undergoing transition can have semi-structured interview technique. It permits
an impact on their health and well-being. During considerable shift within its structure, with the
the developmental transition of fatherhood, in interviewees being free to speak about the subject
particular, in addition to the risks that arise from and express their opinions18 and giving the inter-
the transition process (as in any other), there is viewer the possibility of re-conducting the inter-
also the possibility that the quality of the parent/ view each time the interviewee deviates from the
child interaction and relationship will be com- recommended objectives19.
promised from the start. The open question used to start the inter-
This investigation appears in the context of view was: “How has your experience been since
deepening this phenomenon, seeking to answer the moment you learned you were going to be
the research question How is the process of paren- a father?” Each participant was interviewed only467
Ciência & Saúde Coletiva, 26(2):465-474, 2021
once. The interviews took place from February longing towards the fetus, in a trajectory charac-
to April 2017, at the site where the Childbirth terized by several experienced changes and emo-
Preparation Course took place, which was select- tional responses.
ed by the participants. The conversations were The ultrasound scans and the perception of
recorded using a voice recorder (MP3 device). fetal movements stand out as the key events in
After each interview, the main researcher took this experience, promoting the acceptance of re-
down field notes and transcribed the recordings. ality, which allow men to position themselves in
The interviews were analyzed using the con- an emotional space closer to the pregnancy and
tent analysis technique according to Bardin20, the fetus: When we see them on the ultrasound,
with semantic categorization and an inductive there they are, there is one more reinforcement of
approach. The NVivo Qualitative Solutions Re- reality and that they are really growing [...] and
search (QSR) software, version 11.0, was used for if until then there was any doubt, with the ultra-
data analysis. sound it is “they really exist. I(4); We started to feel
All participants validated the interviews and the baby’s own movements, the kicks, the fact that
the accuracy of the interpretations. Two external we put our hand on the mother’s belly and start
investigators reviewed the interpretations and feeling it, I think this bond gets stronger and stron-
conclusions to ensure credibility. ger I(2).
All ethical principles were met, namely the Men express their involvement in the preg-
free and informed consent, voluntary participa- nancy by showing commitment and responsibil-
tion and the participants’ right to withdraw from ity and being present: I have participated 100% in
the study. Ethical approval was obtained from the the pregnancy, without a doubt, I have been to all
Comissão Nacional de Proteção de Dados (Nation- consultations. I have been trying to go to all of them
al Data Protection Committee) and the Comissão [...] because it is my child, I want to participate in
de Ética da Administração Regional de Saúde do everything, I want to see everything, I don’t know
Norte (Ethics Committee of the Northern Re- if it will be like this with a second child, but at this
gional Health Administration). To safeguard the moment it is like this, I want to go and participate
participants’ anonymity, as well as the confiden- in everything. I have participated in all these expe-
tiality of the data obtained from them, the inter- riences, some are for blood collection, others for the
views were coded (I1 to I10) and destroyed after vaccines. I(9). They try to care for the pregnant
the conclusion of this investigation. woman’s health and well-being and see this care
extended to the child in utero: What I try to do is
make sure that both of them want for nothing, I
Results take care of the mother, so that the daughter is also
well I(6) .
“Experiencing the transition”, “Development of Several changes are felt during this transition,
the father identity” and “(De)constructing bridg- which can be seen as preparatory strategies to as-
es for the transition” are the topics that emerged sume the role of father. They include behavioral
from this investigation, clarifying the develop- changes, which are reflected in smoking cessation
mental transition of becoming a father. They decisions, driving more carefully, a more defen-
highlight the prenatal period as a key moment in sive attitude in extreme sports or other types of
the transition to fatherhood, characterized by the self-care, aiming to ensure they will be present in
enormous psychological and emotional demands their child’s life: When I talk about changing be-
and emerging as the mechanism of the develop- haviors, either on the road, or regarding health or
ment of the father identity. The categories that in my personal life, a child is coming who will need
integrate each of these topics are shown in Chart me for many years, me and the mother, we have
1. to be there as long as life allows us I(8); emotion-
al changes, seeing themselves as more sensitive,
Experiencing the transition calmer and happier, I became more thoughtful and
calmer because I am a very stressed person and I
Experiencing the transition is a topic that start grumbling for anything and everything… I
describes the organization and adaptation path became more thoughtful, calmer too. I(3); physical
that men go through during the pregnancy, from changes, reflected as symptoms usually associat-
the initial period of acceptance of reality to their ed with pregnancy, such as weight gain, nausea,
effective involvement in the pregnancy and the vomiting, fatigue and heartburn, Before the preg-
development of feelings of attachment and be- nancy, I was one of those men who got up early to468
Silva C et al.
Chart 1. Topics and categories resulting from the data analysis.
Topics Categories
Experiencing the transition Acceptance of reality
Involvement in the pregnancy
Experienced changes
Emotional responses
Development of the father identity Redefining values and priorities
Meaning of the paternal role
Sense of responsibility
Reflection on one’s experiences as a son
Feeling like a father
(De)construction of bridges for the transition Support received
Seeking information
Previous experience with babies
Feeling prepared to be a father
Child as a life goal
Meaning attributed to the transition
Exclusion of the father figure
walk my dog and
even at night… now I look like a domain, the ones that are most prevalent in the
pregnant woman, very tired I(3); and changes that men’s experience is the fear of failing as a father
permeate social life, translating into the readjust- and the anxiety related to the responsibility to-
ments they undertake to provide more comfort wards a dependent being and the desire to have
to the pregnant woman or have more time to be the child in their arms and verify that the child
with her: I was a soccer coach for 4 years, now I is healthy.
left because my wife is pregnant, it is something I
had to give up to be with her more often, otherwise Development of the father identity
I would be away for many days, I would always
arrive later I(5). The expected changes after the The topic of the development of the father
child’s birth are also the object of reflection for identity captures the essence of the personal de-
future fathers, as they believe that she [the part- velopment journey that men undertake during
ner] will be more focused on the child than on me, the pregnancy and which will allow them to pre-
but it is normal for that to happen I(6). pare themselves to assume new roles and new
The reported emotional responses are in- responsibilities. During this process, men make
tense and diverse, making pregnancy a complex an assessment of themselves, their experiences as
and demanding period from a psycho-emotion- a child, and their responsibilities and priorities,
al point of view. They oscillate between positive opening up the possibility for changes in values
emotional reactions, such as joy and happiness, and objectives, including the values of profes-
Learning that she was pregnant was a joyful thing, sional life. They place themselves in a psycholog-
it was a huge emotion. I(7), and negative emo- ical and social space that allows them to view life
tional responses, such as fear, anxiety, insecurity in a different way and start to redefine their per-
and concern, The concern that affects me is really sonal values and priorities in the context of being
the baby’s health, I just want her to be well. I(10). a father, I think we start looking at life in a different
The “roller coaster of emotions” metaphor is very way, perhaps giving priority to other things that we
significant of how strong, ambivalent and intense didn’t give before the pregnancy, especially at work;
are the emotions experienced by men during the sometimes we focus too much on work and then,
pregnancy: It’s a roller coaster of emotions, we when we know we are going to be a father, I think
have emotions that makes us very happy because we start thinking about what we have to change in
we are with the baby, and we know that she is preg- our life I(2) . The focus becomes the family and
nant and at the same time we are always afraid the baby that is about to be part of your life.
that something will happen. I(9). Of the vast array As for the meaning of a father’s role, there is
of emotional responses that are in the negative a sense strongly characterized by the role of pro-469
Ciência & Saúde Coletiva, 26(2):465-474, 2021
viding support to the pregnant woman and her an emotional support, that support that I often re-
child in utero, reflecting a changing social con- ceive as a jest even to de-stress, we have even joked
struct: I think men should stop thinking they are about that and these jokes have been very healthy
the ones whose only role is to earn money and be- because, it does not seem like it, but we internalize
ing the providers at home; I think men have to try them. I(9), as well as friends who care about their
to comprehend that they are a key element in the well-being during this transition: Friends are also
pregnancy experience and, therefore, they must be part of this group of people who care, I have friends
very close to this entire process, including the moth- who even send messages every week [...] they are
er’s support and in the affection towards the moth- very important, on this journey we are taking I(5).
er and baby. I(2). The representation of a father In order to prepare for fatherhood, future
figure very present in the child’s daily life stands fathers invest in the search for knowledge. They
out, being a father is to be a full-time father I(8), in look for information on the internet, I really felt
educating, loving and showing affection. the need to look for information on the internet
The pregnancy triggers psychological maturi- about sexuality during pregnancy. Whether we can,
ty and a sense of responsibility, I feel that, but it is whether we should or not, the precautions we must
a good responsibility because I have always wanted take. Yes, I felt the need to search for information, I
to be a father I(1), and prompts men to reflect did have doubts. I(4); in books, I’ve been reading
on their experiences as a child, having as premise since I learned I was going to be a father, there are
the cognitive construction of the parental model things I have heard here that I knew [...] maybe
they want for the future. The construction one’s because I am reading some books I don’t feel the
identity as a father is permeated by the individ- need for information, because I already have it on
ual history of each man and his family patterns, the other side, perhaps that. I(6), and also seek in-
whether to deny them, confront them or confirm formation from friends who are already fathers,
them: I think a lot about it, I think about educa- allowing them to anticipate changes that will
tion, I think about what my education was and in occur and make the experience of pregnancy a
what it could have been different, and let’s say that more peaceful one: I have some friends who are
I can try to avoid some mistakes, something that already fathers and others are from the health area,
could have been better in mine and now try to do and with them I try to get as much information
better for him I(4). The desire for a unique par- as possible [...] this helps us, so that the pregnancy
enting experience, however, remains ever present. path is seen in a more peaceful way, if we don’t look
For some men, feeling like a father emerges for information, if we don’t worry about anything
with the confirmation of pregnancy, the first test, and if something happens, we see ourselves between
when we took the first test, I felt I was a father, I felt a rock and a hard place, and it’s scary. I(9).
there was something there, it is a being in there I Most men report having some previous ex-
(8), but, for others, only childbirth, which has not perience with babies, not only in terms of in-
yet happened, but is close, will allow the identity teraction, but also in providing direct care, and
implementation, I might only feel completely like a this practical knowledge makes them feel more
father on the day my daughter is born I(10). capable of playing the role of a father: I always
had my nephews who came to my parents’ house
(De)construction of bridges [...] and I did everything with them, from chang-
for the transition ing diapers, feeding them, giving them bottles and
going out for a stroll with them [...] Of course,
The (de)construction of bridges for the tran- then I have another experience, I have had some
sition is a topic that seeks to explain the condi- training in that sense, a training that many people
tions that favor or, in contrast, inhibit the expe- do not have. I(3). Very limited experience or the
rience of a positive transition experience by the lack of experience with childcare were also de-
men, along the path to fatherhood. scribed by some participants, causing anxiety in
Most of the men in the study reported receiv- the transition to fatherhood: “I really do not have
ing support during the pregnancy and empha- this experience of taking care of babies, of being
size, in the first place, the spouse as a source of responsible for them. The experience I have is to
support: Yes, I have received a lot of support from stay with them for a very short time, but not being
my wife and I have been giving support too. This responsible for them and so, it causes more anxiety
is mutual I(1). The family also gains prominence because of that. I(4).
in the men’s discourse I have a family circle that, The fact that it is a first pregnancy does not
thank God, is a very strong one [...] It is more of favor men to feel prepared to be fathers, because470
Silva C et al.
nobody is prepared to be a father, at least at the follow their fathers’ educational model when
first time I think nobody is, nobody knows what it they perceive that the education they received
is like, we only know what they tell us I(6). To en- was positive, but above all, men want to be dif-
vision the child as a life goal, that is, the fruit of ferent and better for their child than their own
the desire and pregnancy planning, provides the fathers were for them. The literature confirms
construction of bridges for the transition and en- that the construction of the father identity is in-
courages motivation to overcome it. The mean- fluenced by childhood experiences and the pres-
ing attached to the transition is undoubtedly a ence or absence of father figures in the child’s
positive one; the adjective that best characterizes life21. The perception of an inadequate or unsat-
the transition to fatherhood is “good”: a piece of isfactory experience with their own fathers lead
myself will be born and I really believe that having men to adopt a closer relationship with their own
a daughter will be very good, despite the difficulties children22. This reflection on childhood consti-
I believe I will also have. I(1), which favors the im- tutes a normal reaction to imminent fatherhood
plementation of positive expectations about the and allows solidifying the mental self-image of
process of becoming a father. the type of father the man intends to become6.
The men’s experience during prenatal care It favors the psychological adjustment to the fa-
consultations is described by the participants as ther role and will influence the future parental
being one of the exclusion of the father figure. style23-25. The construction of one’s identity as a
They emphasize a professional speech aimed at father involves a complex subjective, conscious
women, with the man being left out: I think it is and unconscious work, of dealing with the lega-
also part of it, a little bit, for the doctors to give a lit- cies received from their own father and deciding
tle speech also focused on the fathers, and they don’t whether to transmit them to their children25,26.
do that. There are really some fathers who have no When developing the paternal identity, we
idea what it is like to have a child or what it might witnessed the reformulation of men’s values
be [...] Of course, there must always be something and priorities, which is also found in other stud-
for the father, I think, but that does not always hap- ies6,27. They question their own definition of fa-
pen. I(3). therhood and open up the possibility to a new
The distancing they feel from the health pro- conception and way of experiencing fatherhood,
fessionals and the care they provide make men with greater emotional intensity. The affections
characterized themselves as the secondary “char- were transversal to the interviewees’ reports, and
acter” of the story: I feel that I am there playing it is expected that, during the exercise of father-
my role as a father, and they look at me as someone hood, they can occupy a more comfortable place
who is beside the mother only, I have no other type in the home setting, previously occupied only by
of participation [...] in practice, we are really the the woman / mother. Regarding the increase in
secondary character of the story I(7). Therefore, the responsibility and psychological maturity in
they have some suggestions for improvement, so response to imminent fatherhood, the literature
they can feel effectively involved in the prenatal highlights that the perception of the meaning
care. One of the most important concerns the of fatherhood can play a crucial role in the per-
time of the appointments, recognizing they do formance of paternal responsibilities28 and that
not favor the male presence, even if there is a de- maturity is motivated by the child’s dependence
sire to participate: Again, it is the time, either it is related to the satisfaction of their needs29.
in the morning or during the morning, or during The ultrasound and fetal movements were
the afternoon […] I liked it, of course I liked it, but highlighted by men as powerful experiences
I can’t, and then she will pass on the information to in confirming and accepting the pregnancy. In
me and I like to hear it I(8). particular, the ultrasound allows a powerful per-
ception of the baby’s reality and encourages the
rapid expansion of thoughts and feelings about
Discussion becoming a father30. This represents a significant
transitional change, in which men move from
This study highlights the prenatal period as the an emotionally distant space and start feeling
driving force that leads to the development of the more involved with the pregnancy31, with these
paternal identity. During the pregnancy, future moments being considered, by the author, as key
fathers undertake a reflective exercise regarding events in the transition to fatherhood.
the fatherhood model they wish for the future. The desire for involvement with the preg-
The childhood experience encourages them to nancy, demonstrated in the present study, is in471
Ciência & Saúde Coletiva, 26(2):465-474, 2021
line with the findings of Kaye et al.,32 where men tus, not recognizing them as equal partners in the
listed the characteristics of an ideal father in the transition, as shown in other studies44-47.
context of the pregnancy and childbirth. They Men who are recognized in their new posi-
describe him as accessible (present, available) and tion as future fathers and experience emotional
responsible (concerned with the woman, caregiv- support during the pregnancy have better physi-
er and protector), a father who expects and wants cal and psychological health12. The active involve-
to get involved, worries about the pregnancy and ment of men in the pregnancy is associated with
the future child, and wants to be supported by long-term benefits, both in terms of health and
the health system to fulfill his role. social benefits for the mother, the baby and the
This study also corroborates pregnancy as family33,48,49, and is strongly associated with the
a complex and demanding period from a psy- direct involvement of men in postpartum child-
cho-emotional point of view33. The emotional care50. Responding to the men’s needs during the
reactions reported by the men were intense and pregnancy can act as an early intervention for the
ambivalent, findings that are consistent with oth- family system and a reduction in the financial
er investigations, which show male experiences costs for long-term health services6.
of pregnancy characterized by mixed feelings of Although there is clear evidence of gains,
admiration, disbelief, anxiety, fear and insecuri- at several levels, from the early involvement of
ty, in addition to feelings of happiness, emotion, men in prenatal care, their transferability into
joy and pride28,34,35. The anxiety grows as the the clinical practice of health professionals is not
birth approaches. Elevated levels of anxiety and confirmed, perpetuating the men’s invisibility in
depressive symptoms during the pregnancy are prenatal care. What is required of modern man
the most significant predictors of depression in – greater sensitivity and the exercise of a more
men in the postnatal period36, emphasizing the responsible and participatory fatherhood –is not
need for greater support for men in the pre- and reflected in the clinical practices, which contin-
postnatal periods. However, it should be not- ue to create lines of weaknesses in the exercise
ed that men are taught by society to not ask for of fatherhood. The stereotyped lens with which
help and how difficult it can be to do so during fatherhood is viewed translates into a practice
a period when they believe they need to support based on gender, with male discrimination51.
and provide for their partner. The literature is In the light of the transitions theory14, clin-
unanimous in pointing out that men suffer psy- ical practices that exclude the father figure can
chological difficulties in the perinatal period, but be seen as factors that inhibit the transition to
internally, they question the legitimacy of their fatherhood, which may affect one’s perception
experiences, often being reluctant to express of security for assuming his father functions.
their need for support or seek help when facing On the other hand, inclusive practices have the
their concerns. They fear this fact may impair the potential to increase future fathers’ confidence,
meeting of their partners’ needs by health pro- decrease their fear and increase their resilience
fessionals37. in the face of uncertainty and adversity, thus pro-
The literature reinforces that the behavioral, moting a more positive transition. Healthy fami-
emotional, physical and social changes experi- lies, and the paternal roles played within them, do
enced by men in response to their partner’s preg- not happen by chance, but depend on relational
nancy signal the understanding of their responsi- skills, psychological maturation, adequate mod-
bility and an early commitment to the well-being els and stimulating environments, which can and
of their families38-41. The family support network, should develop throughout the pregnancy.
the partner and friends, as providers of emotion- Health professionals can be the connections
al, informative and tangible support41,42, there- that promote a transition to a more positive fa-
fore become crucial in facilitating this transition- therhood. As many of the emotional responses
al process43. experienced by the men are delicate and embar-
During the gestation process, men take a rassing, the professionals must have the sensitiv-
proactive attitude and try to get involved, but ity and a set of communicational and interper-
they find obstacles and not bridges to help their sonal skills and abilities to be able to effectively
transition. The attitude that permeates prenatal support men in this transition. In the scope of
services is, from the perspective of future fathers, health care, men must be included as the focus
a not very inclusive practice regarding the father of attention.
figure. They feel excluded by health professionals, As limitations of this study, it is important to
who focus their care on the woman and the fe- say that its qualitative nature does not allow the472
Silva C et al.
generalization of results, referring us to a contex- studies with first-time fathers and fathers with a
tual reality. The fact that the sample consists only previous experience could also be developed, and
of fathers whose partners attended the Childbirth the investigation could be extended to other stag-
Preparation Course does not allow us to know es of the process of transition to fatherhood, in
whether fathers whose partners who did not at- a longitudinal logic. Another line of future stud-
tend it had the same experiences, so, as a sugges- ies could explore, from the perspective of health
tion, it would be relevant to expand the study to professionals, the reasons for the exclusion of the
include this population of fathers. Comparative father figure from the prenatal period.
Collaborations
C Silva contributed to the study concept and
design, data analysis and interpretation, and the
writing of the manuscript; C Pinto and C Mar-
tins contributed to the study design, data analysis
and interpretation, the writing of the manuscript
and approval of the version for publication.473
Ciência & Saúde Coletiva, 26(2):465-474, 2021
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